Table Of ContentManual of
Childhood
Infections
Oxford Specialist Handbooks published and forthcoming
General Oxford Specialist Oxford Specialist Handbooks
Handbooks in Neurology
A Resuscitation Room Guide Epilepsy
Addiction Medicine Parkinson’s Disease and Other
Day Case Surgery Movement Disorders
Parkinson’s Disease and Other Stroke Medicine 2e
Movement Disorders 2e Oxford Specialist Handbooks
Perioperative Medicine, 2e in Oncology
Pharmaceutical Medicine Practical Management of Complex
Postoperative Complications, 2e Cancer Pain
Renal Transplantation
Oxford Specialist Handbooks
Oxford Specialist Handbooks in in Paediatrics
Accident & Emergency Medicine Paediatric Dermatology
Retrieval Medicine Paediatric Endocrinology and Diabetes
Oxford Specialist Handbooks Paediatric Gastroenterology, Hepatology,
in Anaesthesia and Nutrition
Anaesthesia for Medical and Surgical Paediatric Haematology and Oncology
Emergencies Paediatric Intensive Care
Cardiac Anaesthesia Paediatric Nephrology, 2e
Neuroanaethesia Paediatric Neurology, 2e
Obstetric Anaesthesia Paediatric Radiology
Ophthalmic Anaesthesia Paediatric Respiratory Medicine
Paediatric Anaesthesia Paediatric Rheumatology
Regional Anaesthesia, Stimulation and Oxford Specialist Handbooks
Ultrasound Techniques in Pain Medicine
Thoracic Anaesthesia Spinal Interventions in Pain Management
Oxford Specialist Handbooks Oxford Specialist Handbooks
in Cardiology in Psychiatry
Adult Congenital Heart Disease Addiction Medicine 2e
Cardiac Catheterization and Coronary Child and Adolescent Psychiatry
Intervention Forensic Psychiatry
Cardiac Electrophysiology and Catheter Old Age Psychiatry
Ablation
Oxford Specialist Handbooks
Cardiovascular Computed Tomography
in Radiology
Cardiovascular Magnetic Resonance
Interventional Radiology
Echocardiography, 2e
Musculoskeletal Imaging
Fetal Cardiology
Pulmonary Imaging
Heart Failure, 2e
Thoracic Imaging
Hypertension
Inherited Cardiac Disease Oxford Specialist Handbooks
Nuclear Cardiology in Surgery
Pacemakers and ICDs Cardiothoracic Surgery, 2e
Pulmonary Hypertension Colorectal Surgery
Valvular Heart Disease Gastric and Oesophageal Surgery
Hand Surgery
Oxford Specialist Handbooks
Hepatopancreatobiliary Surgery
in Critical Care
Neurosurgery
Advanced Respiratory Critical Care
Operative Surgery, 2e
Cardiothoracic Critical Care
Oral and Maxillofacial Surgery, 2e
Oxford Specialist Handbooks in Otolaryngology and Head and Neck
End of Life Care Surgery
End of Life Care in Cardiology Paediatric Surgery
End of Life Care in Dementia Plastic and Reconstructive Surgery
End of Life Care in Nephrology Surgical Oncology
End of Life Care in Respiratory Disease Urological Surgery
End of Life in the Intensive Care Unit Vascular Surgery, 2e
Oxford Specialist Handbooks in
Infectious Disease
Infectious Disease Epidemiology
Manual of Childhood Infections 4e
Manual of
Childhood
Infections
Fourth edition
Chief Editor
Mike Sharland
Professor of Paediatric Infectious Diseases,
St George’s Hospital, London, UK
1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
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and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Royal College of Paediatrics & Child Health & European Society of Paediatric
Infectious Diseases 2016
The moral rights of the author have been asserted
First Edition published as Manual of Childhood Infections, 1996
Second Edition published as Manual of Childhood Infections, 2001
Third Edition published 2011
Fourth Edition published 2016
Impression: 1
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ISBN 978–0–19–872922–8
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
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v
Foreword to
the fourth edition
We are very pleased to write a foreword for the fourth edition of the Blue
Book on Childhood infections. The last edition was around five years ago
and this new edition has again been re-written and updated. The book
provides a clinical evidence-based handbook approach to the management
of both common and unusual infections in children. The Editorial Board
has nearly 200 authors writing the 120 chapters of this new edition. The
book has been written by paediatricians, microbiologists, and a wide range
of international experts in paediatric infectious disease. The book is aimed
at both trainee and practising hospital- and community-based paediatricians,
nursing, and other medical staff caring for children in the United Kingdom,
Europe, and internationally. It aims to provide an up-to-date reference guide
including common differential diagnoses, medical management, and infor-
mation on over 100 medicines.
The aim of the book is to improve the evidence-based management to
a child’s infection. This new edition has short abstracts, key references,
and key learning points which are now fully updated. Recent immunisation
campaigns have substantially reduced rates of serious bacterial infection in
children yet new and emerging infections remain a very serious concern.
Rates of hospital-acquired infection are now a serious threat to children and
much remains to be done to reduce nosocomial infection. Antimicrobial
resistance has been flagged by the World Health Organization as one of
the three greatest threats to human health. New chapters on antimicrobial
stewardship demonstrate the way forward for reducing the inappropriate
antibiotic prescribing that drives this very serious problem.
The development of an eBook format now provides a bedside approach
to the practical management of common infections. All paediatricians
should be encouraged to manage a child’s infection using this practical, sim-
ple evidence-based approach.
The European Society for Paediatric Infectious Diseases is very pleased
to be working in partnership with the Royal College of Paediatrics and Child
Health. This edition has an ever-increasing international focus. There is still
considerable variation of practice and management of children’s infection.
Much of this reflects cultural differences and child care practice across
Europe. There is still some variation in practice that cannot necessarily be
explained just by altered prevalence of infections and resistance pattern.
Although evidence-based guidelines will vary across European countries,
the manual is an attempt to be a synthesis of published evidence of sys-
tematic reviews providing the core basic evidence. The Blue Book has been
produced as a teaching tool for trainees internationally and for practising
paediatricians. It can be used as a source to look up, check, or think about
management plans, differential diagnosis, or recent epidemiology. In most
chapters, sections define what is new and what is coming. The Blue Book
also acts to identify future research priorities and aims to encourage collab-
oration across Europe.
vi FOREWORD TO THE FOURTH EDITION
The Blue Book also recognizes that antimicrobial dosing varies consid-
erably across Europe. For this new edition an evidenced approach to the
formulary has been produced and for the first time will provide information
about grading the level of evidence for antimicrobials. The Blue Book again
does not aim to replace national or local formularies but provides a prag-
matic and reasonable summary of the evidence base for each drug.
Professor Neena Modi (RCPCH)
Professor Adam Finn (ESPID)
vii
Contents
Section editors xii
Contributors xiv
Symbols and abbreviations xxi
Section 1 Clinical syndromes
1 Antibacterials 3
2 Antifungals 11
3 Antiparasitics 23
4 Antivirals 31
5 Antimicrobial stewardship 43
6 Bacterial meningitis 49
7 Bone and joint infections 65
8 Cardiac infections 70
9 Central venous catheter infections 93
10 Chronic fatigue syndrome 100
11 Congenital infections 103
12 Diarrhoea and vomiting 112
13 Emerging infections and pandemic preparedness 117
14 Encephalitis 125
15 Enlarged lymph nodes 135
16 Ocular infections 148
17 Immunocompromised children with infection 160
18 Immunization of the immunocompromised child 171
19 Infection control in the community 183
20 Infection control in the hospital 188
21 Laboratory diagnosis of infection 199
22 Lower respiratory tract infection 210
viii CONTENTS
23 Neonatal infections 220
24 Hereditary autoinflammatory diseases 228
25 Pyrexia of unknown origin 234
26 Rash 242
27 Gram-positive bacteria 257
28 Gram-negative infections 263
29 Refugees and internationally adopted children 269
30 The unwell child returning from abroad 274
31 Sepsis syndrome 281
32 Sexually transmitted infections 293
33 Skin and soft tissue infections 300
34 Investigating the child with possible
immunodeficiency 309
35 Invasive fungal infection 326
36 Toxic shock syndrome 334
37 Trauma, bites, and burns 344
38 Travelling abroad with children 350
39 Urinary tract infection 357
40 Upper respiratory tract infections 366
41 Zoonoses 377
Section 2 Specific infections
42 Adenovirus 389
43 Amoebiasis 396
44 Anaerobic infections 402
45 Arboviruses 411
46 Ascariasis 420
47 Aspergillosis 429
48 Botulism 442
49 Brucellosis 446
CONTENTS ix
50 Campylobacter 450
51 Candidiasis 454
52 Cat scratch disease 461
53 Chickenpox—varicella-zoster 464
54 Chlamydia pneumoniae infection 474
55 Chlamydia psittaci infection 477
56 Chlamydia trachomatis infection 479
57 Cholera 484
58 Clostridium difficile 488
59 Conjunctivitis 497
60 Cryptosporidiosis 504
61 Cytomegalovirus 507
62 Dermatophytoses: tinea capitis, corporis,
pedis, and unguium 513
63 Diphtheria 520
64 Enteroviruses (including rhinoviruses)
and parechoviruses 524
65 Rhinovirus 533
66 Giardiasis 537
67 Gonococcal infection 541
68 Haemolytic–uraemic syndrome 545
69 Haemophilus influenzae 554
70 Viral haemorrhagic fevers 560
71 Hand, foot, and mouth disease 568
72 Helicobacter pylori 572
73 Hepatitis A and E 576
74 Hepatitis B 582
75 Hepatitis C 589
76 Herpes simplex virus 1 and 2 594
77 Human immunodeficiency virus infection 602
